title: Daytime observed emotional expressions of people with dementia.
abstract: BACKGROUND
  Emotional expression among people with dementia (PWD) may inform person-centered approaches to care and improvements in dementia-related quality of life.
  
  
  OBJECTIVE
  The aim of this study was to examine frequency and variability of positive and negative emotional expressions, personal factors influencing positive and negative emotional expressions, and trajectories of emotional expression among PWD during daytime hours.
  
  
  METHODS
  We conducted a secondary analysis of daytime positive and negative emotional expressions of 30 PWD living in residential long-term care who completed twelve 20-minute observation periods occurring hourly as part of a multi-site study of wandering behavior. Hierarchical linear modeling was used to examine relationships between influencing factors and frequency of emotional expressions; group-based trajectory analysis was applied to identify clusters of individuals with similar daytime patterns of emotional expression.
  
  
  RESULTS
  Time of day (rate ratio [RR] = 1.05) and impaired mobility (RR = 1.37) significantly influenced positive emotional expression; gender (RR = 1.85), age (RR = 1.03), and education (RR = 0.54) were significantly related to negative emotional expression. Three distinct trajectory groups were identified for positive emotional expression: a low stable group, a fluctuating group displaying afternoon peaking, and a fluctuating group displaying morning peaking. Two trajectory groups were identified for negative emotional expression: a consistent pattern and an inconsistent pattern.
  
  
  CONCLUSIONS
  PWD showed a broad range of emotional expression and significant within-person variation in daytime positive and negative emotional expressions. Observed emotional display is a promising measure of psychological well-being among PWD that, if more fully understood, could guide care approaches to improve quality of life.
authors.affiliation: School of Nursing, Duke University, Durham, NC 27710, USA. kyung.lee@duke.edu
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Lee
authors.forename: Donna L
authors.initials: DL
authors.lastname: Algase
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: McConnell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000523:psychology*; D004644:Emotions; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan; D010414:Pennsylvania; D013997:Time Factors; D055816:Wandering Behavior